Healthcare Provider Details

I. General information

NPI: 1760639884
Provider Name (Legal Business Name): PAUL MICHAEL LEVY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR SUITE 130
CENTERVILLE OH
45459
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR STE 130
CENTERVILLE OH
45459-4094
US

V. Phone/Fax

Practice location:
  • Phone: 937-531-0195
  • Fax: 937-531-0196
Mailing address:
  • Phone: 937-531-0195
  • Fax: 937-531-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34-010479
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: